INTRODUCTION:

Waterborne illnesses continue to pose a major public health challenge worldwide, contributing to over six billion cases of diarrhea annually and ranking among the top causes of death in children, particularly in low- and middle-income nations.¹ Young children are at higher risk due to their underdeveloped immune systems and increased exposure to contaminated water and poor sanitation conditions. Each year, these diseases result in nearly one million fatalities, with the majority affecting children under the age of five. Ingesting or coming into contact with unsafe water not only leads to diarrhea but also hampers school attendance, cognitive growth, and general health^.2 The danger escalates during rainy seasons and in regions with poor infrastructure or ongoing conflict, where children face greater susceptibility to infections such as cholera. Ensuring reliable access to clean water, proper sanitation, and hygiene practices is essential for reducing disease risk and safeguarding child health.³

Waterborne diseases continue to be a major global health issue, claiming around 2.2 million lives each year, with children making up a large share of these deaths. Unsafe water, insufficient sanitation, and poor hygiene contribute to 3.2% of all global deaths, while nearly 780 million people still lack access to safe drinking water. The economic consequences are also significant, with global losses estimated at $12 billion annually. Despite ongoing efforts to improve water quality, the prevalence of waterborne diseases remains high, especially in low- and middle-income nations.⁴ In India, the situation is particularly severe in rural areas, where access to clean water and sanitation is limited.⁵ The country accounts for 10% of the global burden of waterborne diseases, with children in rural regions being especially vulnerable.⁶ A recent study conducted in rural Rajasthan revealed that 40.66% of mothers reported their children experiencing symptoms of waterborne diseases, highlighting the persistent risks and gaps in preventive knowledge. Knowledge among caregivers varied significantly, with only 31% demonstrating a strong understanding of waterborne diseases. A notable association was observed between caregivers' knowledge and factors such as education and income. Rajasthan, one of India's most water-stressed states, faces additional challenges in addressing this issues.⁷ In 2016, waterborne diseases such as diarrhea, typhoid, and paratyphoid were responsible for 8.7% of all deaths in Rajasthan, highlighting the pressing need for effective interventions. Behavioral and infrastructural challenges, such as personal preferences and inadequate water supply, continue to hinder the utilization of sanitation facilities, with a significant portion of households still engaging in open defecation.⁸ The estimated annual cost of implementing a mid-level behavior change communication (BCC) program in Rajasthan is Rs. 125.1 crores. However, the health and productivity benefits from such a program are valued at Rs. 231.5 crores, with an estimated reduction of 41–81 deaths and the prevention of 83,000–167,000 diarrheal cases each year.⁹

At the district level, Kota has made strides in improving water supply infrastructure, with 83% of households having access to fully functional tap connections and 97% receiving potable water. However, only 14% of water samples tested showed residual chlorine within the permissible limits, pointing to ongoing risks of bacteriological contamination. While only 1% of households reported cases of waterborne diseases in the past year, issues such as underreporting and gaps in water quality monitoring continue to be areas of concern.¹⁰The widespread prevalence of waterborne diseases among rural children in Rajasthan, combined with varying levels of awareness and preventive practices, underscores the pressing need for targeted health education interventions.⁸ Research indicates that community-based health education programs can play a crucial role in improving knowledge, attitudes, and behaviors related to the prevention of communicable diseases. In similar contexts, these interventions have led to a notable increase in awareness and the adoption of preventive practices, resulting in a reduction in disease incidence.¹⁰ Given the persistent challenges of waterborne diseases and infrastructure limitations, this study aims to assess the effectiveness of a community-based health education program in enhancing knowledge on disease prevention among rural children in selected villages of Kota district. The findings are expected to inform policy decisions and guide the development of future initiatives to improve public health in underserved rural regions.

PROBLEM STATEMENT:

A study to assess the effectiveness of a community-based health education programme on knowledge regarding prevention of water-borne diseases among rural children in selected villages of Kota district.

OBJECTIVES:

1. To assess the pre-existing knowledge regarding prevention of water-borne diseases among rural children in selected villages.

2. To implement a community-based health education programme on prevention of water-borne diseases management.

3. To evaluate the effectiveness of the programme by comparing pre-test and post-test knowledge scores.

4. To determine the association between pre-test knowledge with selected demographic variables.

HYPOTHESES:

· H₀ (Null Hypothesis): There is no significant difference in knowledge regarding prevention of water-borne diseases among rural children before and after the implementation of the community-based health education programme.

· H₁ (Alternative Hypothesis): There is a significant improvement in knowledge regarding prevention of water-borne diseases among rural children after the implementation of the community-based health education programme.

· H₂ (Alternative Hypothesis): There is a significant association between knowledge score regarding prevention of water-borne diseases among rural children after the implementation of the community-based health education programme.

Assumptions:

· Rural children possess differing levels of baseline knowledge about water-borne diseases and their prevention.

· The community-based health education programme is expected to effectively enhance participants' knowledge of preventive health measures.

· It is assumed that participants will provide accurate and sincere responses during both pre-test and post-test evaluations.

Delimitations:

· The study is limited to selected villages in Kota district and does not represent all rural areas.

· The study includes only rural children and excludes urban populations.

· Only those household members present and willing to participate during data collection will be included.

· The study participants are limited to individuals aged between 12-18 years residing in the selected households.

Conceptual Framework:

This study is based on General System Theory (GST), which views any process as a dynamic and open system involving interaction between various components—input, process, output, and feedback.

Input refers to the resources and information that enter the system. In this study, the input includes the demographic variables of the rural children (such as age, gender, education, occupation, income, type of water source, and sanitation facilities), and their pre-existing knowledge regarding prevention of water-borne diseases.

Process involves the planned intervention. In this study, the process is the implementation of a community-based health education programme designed to enhance knowledge on the prevention of water-borne diseases. The programme covers essential topics such as sources and types of water-borne diseases, symptoms, transmission modes, safe drinking water practices, hygiene, sanitation, and the importance of handwashing.

Output is the result of the process. The expected output in this study is an improvement in the knowledge level of participants, as measured by a comparison of pre-test and post-test scores after the intervention.

Feedback in this system is derived by evaluating the effectiveness of the educational programme. This includes assessing changes in knowledge levels through pre-test and post-test comparisons and analyzing the association between pre-test knowledge and selected demographic variables. This feedback can be used to refine future educational interventions and guide public health planning.

Thus, the framework provides a structured approach to systematically assess the effect of health education on community awareness and can help improve preventive strategies for water-borne diseases.

MATERIALS AND METHODS:

Research Approach:

The quantitative evaluative approach was used in the present study.

Research Design:

Pre-experimental (One group pre-test and post-test research design).

Setting of the Study:

Selected villages of Kota district.

Sample and Sampling technique:

100 rural children aged between 12-18 years were selected by purposive sampling technique

Variables:

Dependent Variables:

Knowledge regarding prevention of water-borne diseases (measured through the structured questionnaires).

Independent Variable:

Community-based health education programme on prevention of water-borne diseases management.

Description of tool:

Part I: Demographic data

Part II: Structured questionnaire for knowledge assessment.

Content validity of tool:

The content validity of the tools was established by a panel of five experts, which included four nursing educators from different specialties and one statistician. Their evaluation ensured the appropriateness, relevance, and clarity of the items included in the structured knowledge questionnaire.

Reliability of the tool:

A pilot study was conducted to assess the clarity, feasibility, and reliability of the instrument. Permission was obtained from the competent authorities, and a pre-test of the structured knowledge questionnaire was conducted among five rural children with prevention of water-borne diseases residing in a selected rural area. The reliability coefficient (r-value) of the tool was found to be 0.95, indicating a high level of reliability. The results were statistically significant at p < 0.05, confirming the tool’s consistency in measuring knowledge regarding prevention of water-borne diseases.

Data collection:

The data collection was carried out in two phases:

· Pre-test: Structured knowledge questionnaires were administered to assess participants' baseline knowledge regarding prevention of water-borne diseases.

· Intervention: On the same day, a community-based health education programme on prevention of water-borne diseases was implemented, covering aspects such as sources and types of water-borne diseases, symptoms, transmission modes, safe drinking water practices, hygiene, sanitation, and the importance of hand washing.

· Post-test: After seven days, a post-test was conducted using the same structured knowledge questionnaire to evaluate the effectiveness of the community-based health education programme.

Analysis and interpretation:

The collected data were analyzed using both descriptive and inferential statistics.

· Descriptive statistics such as mean, standard deviation, frequency, and percentage were used to summarize the demographic data and pre-test and post-test scores.

· Inferential statistics such as paired t-test and chi-square test were used to assess the effectiveness of the health education programme and determine associations between knowledge and selected demographic variables.

RESULT:

Section-I: Description of samples demographic data.

Section-II: Distribution of samples according to grading of pre-test and post-test knowledge score.

Section-III: Evaluate the effectiveness of community-based health education programme on prevention of water-borne diseases in terms of knowledge.

Section-IV: Association between the pre-test knowledge score with their selected demographic variables.

Section I: Description of Samples Demographic Data:

Table-1: Frequency & percentage distribution of samples based on demographic data [N = 100]

S. No	Demographic Variable		Frequency (n)	Percentage (%)
1	Age (in years)	12-13	20	20.00
		14-15	22	22.00
		16-17	33	33.00
		18 and above	25	25.00
2	Gender	Male	37	37.00
2	Gender	Female	63	63.00
3	Education	Illiterate	32	32.00
		Primary	12	12.00
		Secondary	22	22.00
		Higher Secondary & Above	34	34.00
4	Occupation	Farmer	38	38.00
		Laborer	32	32.00
		Homemaker	20	20.00
		Other	10	10.00
5	Monthly Income	Less than ₹5000	26	26.00
		₹5001–₹10,000	3	3.00
		₹10,001–₹15,000	36	36.00
		More than ₹15,000	35	35.00
6	Type of Water Source	Tap water	37	37.00
		Hand pump	36	36.00
		Well water	27	27.00
		Other	0	0.00
7	Sanitation Facilities	Open defecation	36	36.00
		Pit latrine	33	33.00
		Flush toilet	31	31.00
8	Pre-existing Knowledge on Prevention of Water-borne Diseases	Yes	27	27.00
8		No	73	73.00

Section-II: Distribution of Samples According to Grading of Pre-Test and Post-Test Knowledge Score

Table-2: Frequency & percentage distribution of samples based on grading of pre-test and post-test knowledge score [N = 100]

Level of Knowledge	Pre-test		Post-test
Level of Knowledge	Frequency (n)	Percentage (%)	Frequency (n)	Percentage (%)
Inadequate Knowledge	66	66.00	0	0.00
Moderate Knowledge	34	34.00	22	22.00
Adequate Knowledge	0	0.00	78	78.00
TOTAL	100	100.00	100	100.00

Table-3: Mean Score, Mean Difference, SD & ‘t’ Value of pre & post–test knowledge score [N = 100]

Variable	Test	Mean	Mean Percentage (%)	SD	Mean Difference	SE	Calculated ‘t’ Value	Tabulated ‘t’ Value
Knowledge	Pre-test	10.82	36.56	2.14	22.7	0.363	22.662*	1.646
Knowledge	Post-test	33.52	76.88	2.37	22.7	0.363	22.662*	1.646

Note: *t= p < 0.05 df= 99

Section-III: Evaluate the Effectiveness of Community-Based Health Education Programme on Prevention of Water-Borne Diseases in Terms of Knowledge

The analysis of data in Table-3 clearly showed that the community-based health education programme significantly enhanced the knowledge of rural children regarding the prevention of water-borne diseases. The average knowledge score increased from 10.82 before the intervention to 33.52 after, indicating a notable mean difference of 22.7. Similarly, the mean percentage of knowledge rose from 36.56% to 76.88%, reflecting a marked improvement in awareness post-intervention. The standard deviation values-2.14 for the pre-test and 2.37 for the post-test-indicated consistent data in both assessments. The computed paired t-value of 22.662 was much higher than the critical t-value of 1.646 at p < 0.05 with 99 degrees of freedom, confirming that the knowledge gain was statistically significant. These findings demonstrated the effectiveness of the health education programme in improving knowledge levels related to water-borne disease prevention. This underscored the importance of structured, community-oriented educational efforts in advancing rural health and reducing preventable illnesses. Consequently, the research hypothesis (H₁) was upheld, and the null hypothesis (H₀) was rejected.

Section-IV: Association between the Pre-Test Knowledge Score with Their Selected Demographic Variables:

The relationship between pre-test knowledge scores and various demographic factors was examined using the chi-square test. The analysis revealed statistically significant associations between knowledge levels and specific variables, including gender (χ² = 4.322, p < 0.05), education level (χ² = 13.124, p < 0.05), monthly income (χ² = 15.661, p < 0.05), sanitation facilities (χ² = 10.321, p < 0.05), and prior awareness of water-borne disease prevention (χ² = 5.112, p < 0.05). In contrast, no significant associations were found with age (χ² = 8.213), occupation (χ² = 9.183), or type of water source (χ² = 11.621), as their p-values exceeded 0.05. These findings suggested that certain demographic characteristics significantly influenced baseline knowledge about preventing water-borne diseases. As a result, the research hypothesis (H₂) was supported, while the null hypothesis was rejected.

DISCUSSION:

The present study evaluated the effectiveness of a community-based health education programme in improving knowledge regarding the prevention of water-borne diseases among rural children aged 12–18 years. The findings showed a statistically significant increase in mean knowledge scores from 10.82(pre-test) to 33.52 (post-test), with a paired t-value of 22.662(p<0.05), confirming the programme’s substantial impact. These results align with those of Sharma et al. (2020), who also reported a significant improvement in post-intervention knowledge levels among rural children. Similarly, Singh et al. (2019) found that community health education enhanced compliance with preventive practices, further supporting the effectiveness of structured interventions. Improvements in self-care behaviors observed in this study mirror the findings of Patel and Mehta (2021), who demonstrated that tailored health education improved lifestyle-based disease prevention. However, the moderate improvements reported by Kumar et al. (2018) highlight the influence of contextual variables such as educational background and intervention methods. These variations emphasize the necessity of culturally sensitive and context-specific education strategies to optimize outcomes. Overall, the present study provides strong evidence that structured, community-based health education is an effective approach to increasing disease prevention knowledge and promoting healthier behaviors among vulnerable rural populations.

CONCLUSION:

The study demonstrated that a community-based health education programme effectively improved knowledge on preventing water-borne diseases among rural children. The significant post-intervention knowledge gain highlights the value of structured educational efforts. Consistent with previous research, the findings support the role of targeted, culturally appropriate interventions in promoting preventive practices and improving rural health outcomes.

CONFLICT OF INTEREST:

The authors declare that there are no competing interests related to this study.

ACKNOWLEDGMENTS:

The authors express their sincere gratitude to the institutional authorities, participants, and all those who contributed to the successful completion of this study. Their valuable support and cooperation were instrumental in conducting this research.

REFERENCES:

1. Arya A, Bisht V, Pandey U, Danu S, Simran, Kumar S, Supriya, Chauhan S, Dhami T, Khati T, Haldar P, Nayal P, Jaiswal P. Knowledge regarding water borne diseases and its prevention. Asian J Nurs Educ Res. 2019; 9(4): 501–503. doi:10.5958/2349-2996.2019.00105.8

2. Mathew S. A study to determine the effectiveness of structured teaching programme on knowledge and attitude regarding ear infection, management and its prevention among mothers of under five children in selected rural areas of Udupi District. Int J Nurs Educ Res. 2016; 4(3): 282–294. doi:10.5958/2454-2660.2016.00052.1

3. Venu AS, Shilpa GK. Effectiveness of structured teaching programme on knowledge and knowledge on practice of common newborn care among primi mothers at selected hospitals, Hubli, Karnataka. Int J Nurs Educ Res. 2016; 4(2): 111–115. doi:10.5958/2454-2660.2016.00025.9

4. Mansuri AK. A study to assess the effectiveness of planned teaching programme on management of dysmenorrhoea in terms of knowledge and attitude among adolescent girls studying in selected schools of Gujarat State. Int J Nurs Educ Res. 2016; 4(2): 116–118. doi:10.5958/2454-2660.2016.00026.0

5. Bevoor D, Moreshwar S, Madhale M. A study to evaluate the effectiveness of planned teaching programme on knowledge on prevention and control of malnutrition among mothers of under five children residing in Vantmuri Primary Health Centre of Belgaum City, Karnataka. Int J Nurs Educ Res. 2015; 3(3): 317–320. doi:10.5958/2454-2660.2015.00014.9

6. Gnanagowri V. A quasi experimental study to evaluate the effectiveness of structured teaching program on knowledge regarding health hazards of junk foods among school children at selected school, Chennai. Int J Nurs Educ Res. 2015;3(1):33–39.

7. Doss JJ. Effectiveness of planned health teaching regarding ill-effects of junk food among the students of Joitiba College of Nursing, Bhandu, Gujarat. Int J Nurs Educ Res. 2014; 2(4): 376–378.

8. Kaur J, Kaur J, Kaur K, Kaur KJS, Kaur K, Singh L, Kaur L, Kaur M, Kaur MAS, Kaur MBS, Kaur MHS, Kaur MRS, Jacob T. Effectiveness of planned teaching programme on knowledge regarding lifestyle changes in prevention of pre-menstrual syndrome among adolescent girls in a selected school at Dehlon, Ludhiana. Int J Nurs Educ Res. 2016; 4(3): 327–339.

9. Prasannakumar DR. A comparative study to assess the knowledge of mothers of under-five children regarding importance of play in growth and development in selected rural and urban areas, Bangalore. Int J Nurs Educ Res. 2014; 2(1): 77–80.

10. Kumari M, Kaur L, Kaur M. Assessment of knowledge and practices of people regarding dengue fever. Int J Nurs Educ Res. 2016; 4(2): 174–178. doi:10.5958/2454-2660.2016.00035.1

Received on 08.05.2025 Revised on 30.06.2025

Accepted on 05.08.2025 Published on 27.10.2025

Available online from November 08, 2025

Int. J. Nursing Education and Research. 2025;13(4):237-242.

DOI: 10.52711/2454-2660.2025.00048

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.